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-cardiopulm Npte > cardiopulm exam 1/18 (ptfe) > Flashcards

cardiopulm exam 1/18 (ptfe) Flashcards

1
Q 
what pathology?
• Fatigue, pulmonary  edema 
• Fluid weight gain
• Dyspnea
• S3 heart sound
• Crackles in lung (fluid in lung)
• Orthopnea
A

L sided CHF

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2
Q 
what pathology?
• Fatigue, edema rest of body
• jugular distension
• Fluid weight gain
• S3 heart sound
• Orthopnea
A

R sided CHF

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3
Q

what used to test DVT?

A

wells criteria

homans sign - squeeze calf

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4
Q

DVT pop?

A

women more than men, esp. over 50 y.o.

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5
Q 
what pathology?
• Often asymptomatic
• Pain in the region
• Unilateral swelling, tenderness, and pain
• Warmth and discoloration
• Homan’s sign
A

deep vein thrombosis

• blood clots in pelvis, leg, or major UE veins

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6
Q

how DVT diagnosed?

how treated?

A

ultrasonography

anticoagulants

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7
Q 
what pathology?
• Dyspnea
• Pleuritic, sharp, localized chest pain 
• Diffuse chest discomfort
• Persistent cough
• Hemoptysis
• Tachypnea, tachycardia
• Apprehension, anxiety, restlessness
A

pulmonary embolism

- Pulmonary vascular obstruction by displaced thrombus

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8
Q

symptoms:
• Bruit heard over swollen area (listen with stethoscope)
• Abdominal/back/flank pain
• Leg pain, claudication
• Poor distal pulses
• Pulsating mass in the abdominal area (sometimes)

A

Abdominal Aortic Aneurysm

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9
Q

what heart sound?

AV valve closure (onset of systole)

A

S1

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10
Q 
what heart sound?
 Semilunar valve (pulmonary/aortic) closure (onset of diastole)
A

S2

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11
Q

what heart sound?

heard in early diastole associated with CHF, athletes (“Kentucky”)

A

S3

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12
Q

what heart sound?

heard in late diastole associated with MI or hypertension (“Tennessee”)

A

S4

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13
Q

What nerve?
primary innervator of PNS for most of viscera
what action?

A

Vagus CNX
• Decreases heart rate
• Decreases blood pressure

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14
Q

how to stimulate CN X?

A
  • Carotid sinus massage
  • Valsalva maneuver
  • Pain
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15
Q

signs of CN X lesion

A

dysphagia, difficulty swallowing

gag reflex, uvula deviates to strong side

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16
Q

what maneuver?
Intrathoracic pressure increased against a closed glottis
what effects?

A

valsalva
• Collapsed veins reduce BP and HR
• Overshoot of ↑ BP and ↓HR

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17
Q

when to use valsalva maneuver?

A

supraventricular tachycardia

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18
Q

muscles contract to elevate ribs during inspiration

A

external intercostal

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19
Q

muscle contracts to to expand thoracic cavity, flattens when contract

A

diaphragm

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20
Q

accessory muscle for inspiration

- contracts to elevate sternum

A

SCM

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21
Q

accessory muscle for inspiration

- contracts to pull ribs outward

A

pec minor

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22
Q

muscle contracts to to contract pull ribs down during expiration

A

internal intercostals

quadratus lumborum

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23
Q

muscle relaxes to reduce thoracic cavity during expiration

A

diaphragm

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24
Q

accessory muscle for expiration

- contracts to compress abdomen

A

abdominals

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25
Q

contralateral tracheal deviation

A

space occupying:
Tension Pneumothorax
Pleural effusion
Space-occupying lesion

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26
Q

tracheal ipsilateral deviation

A

collapse:
Pneumonectomy
Pleural Fibrosis
Atelectasis (collapse of part/all of lung)

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27
Q

what pathology?

  • life-threatening condition
  • air leaks into the space between the lungs and chest wall
  • air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function
A

Tension Pneumothorax

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28
Q

what pathology?

“water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs.

A

Pleural effusion

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29
Q

right pneumonectomy - which way does trachea deviate?

A

right deviated trachea

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30
Q

what kind of breath sound?

caused by CHF, air bubbles, fluid in the alveoli

A

Crackles (rales)

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31
Q

what kind of breath sound?
• Pulmonary edema,
pulmonary fibrosis,
infection of small bronchioles

A

Crackles (rales)

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32
Q

what kind of breath sound?

High-pitched wheezing

A

Wheezes

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33
Q

what kind of breath sound?

Asthma, partially obstructed bronchi/bronchioles

A

Wheezes

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34
Q

what kind of breath sound?

Low pitched wheezing, sonorous sleeping/snoring

A

Rhonchi, snoring rhino

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35
Q 
what kind of breath sound?
• Pneumonia, 
bronchitis, 
cystic fibrosis, 
COPD, 
secretions in larger airways
A

Rhonchi snoring rhino

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36
Q

what kind of breath sound?

High-pitched wheezing, upper airway blockage/object

A

Stridor

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37
Q 
what kind of breath sound?
Tracheal Stenosis (narrowing of your trachea) or object obstruction
A

Stridor

38
Q

what kind of breath sound?
rapid breathing followed by apnea/cardiac failure
- end of life

A

Cheyne-stokes Respirations

39
Q

Xray passes through

- air is black

A

radiolucent

40
Q

Xray cannot pass through

- bone, metal is white

A

radioopaque

41
Q

lung so full of fluid shows up white on Xray
- air that usually fills the small airways in your lungs is replaced with something else, eg. fluid, such as pus, blood, or water

A

Consolidated lung

42
Q

which breathing technique?
• Unresisted inspiration
• Exhalation through pursed lips
• Prevents airway collapse, better gas exchange

A

pursed lip breathing

43
Q

which breathing technique?
• To mobilize secretions (e.g. Cystic Fibrosis)
• Exhaling through open mouth (as if to steam a mirror)
• “HAA” “HAA”

A

huffing

44
Q

which breathing technique?

  1. Breathing control (relaxed)
  2. Deep breathing (thoracic expansion) Deep breath with 3- second hold
  3. Huffing maneuver to mobilize secretions
A

Active Cycle Breathing

45
Q 
what pathology?
• Smoking, occupational exposures, pollutants
• Hypoxemia, hypercapnia
• Hyperinflation “barrel chest” 
• Cyanosis, nail clubbing
A

COPD

Chronic airway obstruction

46
Q

what pathology?
• C8, T1, T2 Dermatome paresthesias (similar thoracic outlet)
• horner’s syndrome (Miosis, ptosis, enophthalmos)
• Sharp shoulder pain, axilla, subscapular area
• Pulmonary symptoms - Dyspnea, cough, hemoptysis
what is it mistaken for?

A

Pancoast’s Tumor- Apical tumor of lung

mistaken for: thoracic outlet syndrome, OA, or impingement

47
Q

what pathology?
- miosis (constriction of the pupil),
- ptosis (drooping of the upper eyelid),
- anhidrosis (absence of sweating of the face)
- Enophthalmos is the posterior displacement of the eyeball within the orbit
cause?

A

horner’s syndrome

- caused by damage to the sympathetic nerves of the face.

48
Q

what patholoyg?

  • muscles of the forearm, wrist and hand are most affected
  • caused by a birth injury to the neck and shoulder due to a difficult vaginal delivery, tumor of the lung or shoulder, or trauma to the arm and shoulder.
  • brachial plexus nerves may be stretched or torn, causing weakness, pain or numbness.
A

Klumpke’s palsy

49
Q

what breathing pattern?

large breaths with periods of apnea

A

Biots

50
Q

what breathing pattern?

rapid breaths with periods of apnea, near end of life

A

Cheyne-stokes

51
Q

what breathing pattern?
in response to acidosis, body tries to breathe acid (CO2) out
- think boy scout blowing to start fire

A

Kussmaul

52
Q

AHA classification for BP:

normal

A

<120 mmHG AND <80 mmHG

53
Q

AHA classification for BP:

Elevated

A

120-129 mmHG AND <80mmHG

54
Q

AHA classification for BP:

Stage 1 Hypertension

A

130-139 mmHG OR 80-89 mmHG

55
Q

AHA classification for BP:

Stage 2 Hypertension

A

≥140 mmHG OR ≥ 90 mmHG

56
Q

what term?

amount of blood in ventricle at the end of diastole (LVEDV)

A

Preload

57
Q

what term?

force the LV must generate to overcome aortic pressure

A

Afterload

58
Q

what term?

amount of blood ejected with each contraction

A

Stroke volume

59
Q

what term?
% of blood ejected from total volume of ventricle
normal?
how to calculate?

A

Ejection fraction
• Normal 55-75%
- calculate with echosonogram

60
Q

what do you expect in patient with low Ejection fraction? eg. 12%

A

expect fatigue, dyspnea, multiple rest breaks for ADL

61
Q

CV response to exercise

increased O2 demand and increased external load

A
  • HR increases linearly
  • SBP increases linearly
  • DBP limited changes (+/- 10 mmHg)
  • Tidal volume and respiratory rate increase
62
Q

UE or LE?

has increased sympathetic activity during exercise, greater increase in HR

A

UE 30-40% more than LE

63
Q

UE or LE?

increase O2 demand during exercise

A

LE more muscle mass

64
Q

UE or LE?
Lower mechanical efficiency
more energy cost
Needs to recruit additional stabilizing postural muscles

A

UE (LE has more mass)

65
Q

what protein further the vasoconstriction in all non-working muscles during sympathetic activity?

A

catecholamines

66
Q 
normal or abnormal response to exercise?
• Moderate to severe, increasing angina
Marked dyspnea
• Dizziness, light-headedness, ataxia
• Cyanosis/pallor
• Excessive fatigue
A

abnormal

67
Q

normal or abnormal response to exercise?

• BP response 150/120

A

abnormal, Hypertensive

>180/>110

68
Q

normal or abnormal response to exercise?

SBP rise 10mmHg

A

normal

69
Q

normal or abnormal response to exercise?

SBP drop 10-15mmHg

A

abnormal

70
Q

normal or abnormal response to exercise?
Significant change in EKG rhythm
next steps?

A

abnormal
wait to return to baseline
If ST elevation = emergency, call 911

71
Q

normal or abnormal response to exercise?

• Blunted BP response

A

abnormal

normal if on metoprolol, beta blocker

72
Q

normal or abnormal response to exercise?

• Leg cramps, claudication

A

abnormal

73
Q

if angina, what medication to take?
how to take it?
what next steps if no response?

A

nitroglycerin - vasodilator, a medicine that opens blood vessels to improve blood flow and angina symptoms
- sublingual, under the tongue
1 tab every 5 mins, up to 3x
- call 911 if unrelieved

74
Q

what pathology?
• chest pressure doesn’t change w position, etc
• Occurs at rest without precipitating factors
• Requires immediate medical intervention

A

unstable angina

75
Q

what pathology?
• ischemic chest pain
• Experienced at predictable workloads/effort

A

stable angina

76
Q

what pathology?
• Vasospasm, responds to nitroglycerin treatment
• Need referral for calcium channel blocker
• occurs at rest

A

Prinzmetal angina

77
Q

related to what pathology?
• Decreased O2 perfusion
• Tissue injury and infarction

A

Myocardial infarction - heart attack

78
Q

related to what pathology?

• Insufficient BP to heart and vital organs

A

MI • Cardiogenic shock

79
Q

related to what pathology?
• Pt complaints- chest pain, radiate to L arm, jaw, thorax, fatigue, weakness
• ECG
• Cardiac enzymes (• Creatine kinase-myocardial band • Lactic dehydrogenase • Troponin • Myoglobin)

A

MI acute coronary syndrome

80
Q

patient complaints for MI

A
  • Intense chest pressure “elephant on my chest”
  • pounding headache
  • Radiating pain to left arm, jaw, and thorax
  • Compromised cardiac output, dizziness, light headed, sweating
  • Fatigue, weakness
81
Q

female complaints for MI that can be different than men?

symptoms relieved by?

A
  • Mental status changes (older female)
  • Dyspnea
  • Weakness, lethargy
  • GERD pain
  • Anxiety, Depression
  • Sensation of inhaling “cold air”
  • Achiness, heaviness, weakness of UE’s
  • Symptoms relieved by antacids
82
Q

what medication used?

• hyperlipidemia with coronary artery disease

A

statin

83
Q 
side effects of what drug?
• Myalgia, myopathy
• Liver impairment
(Asterixis, Carpal tunnel syndrome, Ascites, etc.)
• Rhabdomyolysis 
• Fever
• Nausea/vomiting
A

statin

84
Q 
what situation?
- rapid skeletal muscle breakdown, 
- goes to kidney work 
overtime to filter out, 
- dark brown urine 
what causes?
A

rhabdomyolysis

causes - overtraining, crush injury MVA, statin electrical injury

85
Q

what symptom of liver impairment?

clonus of wrist, extension cause flapping

A

asterixis

86
Q

what pathology?
symptoms mimic MI
no tissue death
improve with change in position- valsalva, lean forward/quadruped

A

pericarditis

87
Q

causes of inflammation of pericardium

A

pericarditis
• Trauma
• Autoimmune, radiation
• Idiopathic

88
Q 
what pathology? symptoms:
• Chest pain/dyspnea
• Pain aggravated by trunk movement
• Fever, chills, cough
• LE edema
• Pain relieved by holding breath or leaning forward/ sitting upright/ kneeling on all fours
A

pericarditis

89
Q

what pathology?

pericardial sac filled with fluid, crush heart

A

cardiac tamponade

90
Q 
what pathology? caused by
• Hypertension
• coronary artery disease
• Dysrhythmias
• Valve abnormalities
• Pericardial pathology 
• Cardiomyopathies
results: bad heart pumping action, low cardiac output, renal dysfunction because kidneys detect less fluid
A

CHF

91
Q

endocrine disorder most common cause of exophthalmos.

A

Graves’ disease

-cardiopulm Npte (17 decks)

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